Part Two of Two

The American College of Obstetricians and Gynecologists (ACOG) considers an episiotomy to be minor surgery. Despite this designation, many obstetricians routinely use this medical intervention in healthy, normal births. In April of 2006, the ACOG published a statement acknowledging that “women who have an episiotomy do not have significantly improved labor, delivery, and recovery compared with those who do not have one. The best available data does not support the liberal or routine use of episiotomy.” So why the discrepancy between real life use and researched need?

Not surprisingly, there is no set criteria which a doctor must follow when making the decision to perform an episiotomy. As such, a doctor has full license to perform the surgery without consent whether or not it’s needed. Further, there is no current disciplinary action or accountability to penalize doctors who grossly overuse it or cause permanent damage. And, as a result, at least half of women who have given birth in the U.S. live with the consequences.

In comparison, there is a drastic difference in episiotomy use among MD’s than that of Certified Nurse Midwives. Across the board, midwives report radically lower percentages of use with some rates in the 1 or 2% range. Some midwife practices report well below one or even zero percent—a stark contrast to those condoned by the ACOG. This irrefutable evidence proves that episiotomies in as much as 75% of laboring women is unnecessary and, as some have suggested, obvious abuse.

Yet, the ACOG shows no signs of discouraging rampant cutting of a woman’s perineum during labor. On the contrary, the organization just released a new 2007 teaching aid for new doctors confirming that indeed “episiotomy is the most common operative procedure that most obstetricians will perform in their lifetime. Because it is so common, teaching students or interns the principles and techniques usually is left to the most junior of residents.” With the procedure being taught during childbirth in the delivery room by junior level doctors, it begs the questions: who is monitoring how it’s really being taught and when is it advisable? Issuing a pocket-sized booklet is a far cry from implementing rules of conduct and liability.

Still, it’s pure speculation as to why doctors choose the procedure so often. Perhaps, it is lack of accountability. Perhaps, it’s impatience. Perhaps, it’s because antiquated practices die hard. Instead of making any rush judgments, it is my hope to work toward educating mothers and doctors. Public awareness and activism can force the ACOG to set the standards and accountability that are far overdue. Until then, the only recourse is to spread the word; to educate women about how to choose a responsible practitioner and what questions to ask her maternity team. It’s a mother’s choice to make informed decisions about healthcare, the people who attend births and labor preparation techniques. Mothers do have the option to take a proactive stance, to embrace our ability to birth naturally, and to change the common misconception that a healthy normal labor would need to be medicalized in any way.
See Episiotomy Part One: What your doctor isn’t telling you

See Five things you can do to prevent an episiotomy

Resources:
americanpregnancy.org
acog.org
childbirthconnection.org
bmj.com
jwatch.org/
midwiferytoday.com
A Wise Birth: Bringing Together the Best of Natural Birth with Modern Medicine by Penny Armstrong and Sheryl Feldman
Ina May’s Guide to Childbirth by Ina May Gaskin

Share This